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Cancer Prevention

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Title: The Challenge of Cancer Author: Brenda J Wilson Last modified by: Faculty of Medicine Created Date: 4/19/2000 12:57:35 PM Document presentation format – PowerPoint PPT presentation

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Learn more at: http://www.med.uottawa.ca
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Title: Cancer Prevention


1
Cancer Prevention
  • Dr Brenda Wilson
  • Department of
  • Epidemiology Community Medicine

2
Global burden of cancer
  • IARC estimates of new cancer patients in 2000
  • All countries 5,300,000
  • Developed 2,500,000
  • Less developed 2,800,000

3
Cancer is a disease of rich countries
4
But cancer is not necessarily a disease of rich
people
5
Burden of cancer Canada
  • 134,000 new cases per year
  • 65,000 deaths per year
  • Lifetime risk of developing cancer
  • males 40
  • females 35

6
Time trends all cancers in Canada
Standardized incidence rate per 100,000
500
400
300
200
100
0
1975
1980
1985
1990
1995
2000
Year
Females
Males
7
Geographical variation in Canada
Fewestcases
Most
8
Canada commonest male cancers
Standardized rate per 100,000 (1998)
9
Time trends male cancers
Standardized incidence rate per 100,000
10
Canada commonest female cancers
Standardized rate per 100,000 (1998)
11
Time trends female cancers
Standardized rate per 100,000
12
Time trends lung cancer
Standardized incidence rate per 100,000
13
Lung cancer - men
Fewest
Most
14
Lung cancer - women
Fewest
Most
15
Lung cancer risk factors
  • Tobacco
  • Occupational exposures asbestos, arsenic,
    polycyclic aromatic hydrocarbons, chromium,
    silica, nickel
  • Radon, radon daughters (occupational, domestic)
  • Protective effect of fruit vegetables?
  • Genetic predisposition

16
Time trends colorectal cancer
Standardized incidence rate per 100,000
17
Colorectal cancer men women
18
Colorectal cancer risk factors
  • Family history
  • Diet
  • Ulcerative colitis Crohns disease
  • Obesity
  • Lack of exercise (colon)

19
Time trends melanoma
Standardized rate per 100,000
20
Melanoma men women
21
Melanoma risk factors
  • Gender
  • Fair skin
  • UV exposure patterns
  • Tanning predisposition
  • Number of naevi
  • Dysplastic naevi
  • Family history

22
Time trends breast cancer
Standardized rate per 100,000
23
Breast
24
Breast risk factors
  • Age
  • Family history
  • Obesity
  • Hormonal effects
  • nulliparity
  • age of first pregnancy
  • early menarche
  • late menopause
  • Socioeconomic status
  • Benign breast disease (some)
  • Radiation to chest

25
Time trends cervix cancer
Standardized rate per 100,000
26
Cervix
27
Cervical cancer risk factors
  • Age at first intercourse
  • Number of sexual partners
  • Age
  • Smoking habit
  • Socioeconomic status
  • Oral contraceptive use
  • Nutritional deficiencies?

28
Time trends prostate cancer
Standardized rate per 100,000
29
Prostate
30
Prostate risk factors
  • Fat consumption
  • Androgens
  • Ethnic group
  • Family history
  • ?role of vitamins

31
Estimated preventable cancer deaths
  • Smoking 30
  • Diet 20-50
  • Infections 10-20
  • Reproductive hormones 10-20
  • Alcohol 5
  • EM radiation 6
  • Occupational exposures 3
  • Pollution up to 5

32
Risk factors
  • Tobacco
  • Diet exercise
  • UV exposure
  • Viral infection
  • Genetic susceptibility

33
Tobacco in Canada
  • 29 of adults smoke (gt6m)
  • 1.4 million children exposed to tobacco smoke at
    home
  • Complete elimination of smoking could prevent
    gt38,000 cancer cases, 18,000 cancer-associated
    deaths annually

34
Available interventions
  • Individual
  • smoking prevention
  • smoking cessation
  • healthier diet
  • Societal level
  • Restrict availability
  • Restrict advertising
  • increase cost
  • smoking bans

35
Diet exercise in Canada
  • Most Canadians not meeting even minimum
    recommendations for fruit vegetable
    consumption, most unaware of recommendations
  • 57 inactive during leisure time
  • Daily diets high in vegetables and fruit decrease
    cancer incidence by 20
  • Healthy diet, physical activity, body mass
    reduces cancer incidence by 30-40
  • Improve nutrition, reduce obesity could prevent
    gt161,000 cancer cases, 12,000 deaths

36
Available interventions
  • Individual
  • Healthy eating campaigns, initiatives
  • Food preparation tips
  • Shopping skills
  • Physical activity in school curricula
  • Societal
  • Food fortification
  • Increase access to healthier foods
  • Increase nutritional information
  • Increase accessibility of places for physical
    activity

37
UV radiation in Canada
  • Repeated exposure to the sun related to risk of
    melanoma 66 000 new cases in 1999 in Canada
  • Half of adults do not adequately protect
    themselves against the sun. About 45 parents
    report that at least one of their children was
    sunburned at least once in the past summer
  • Reduction of over-exposure to sun prevents
    ?13,800 melanoma cases

38
Available interventions
  • Individual
  • Education
  • Societal
  • School policies
  • Occupational protection
  • Availability of protection

39
Viral infections available interventions
  • Cervical cancer
  • Education
  • Barrier methods of contraception
  • Vaccines?

40
Environmental carcinogens
  • Tobacco smoke, pesticides, radon, chlorinated
    disinfection by-products in drinking water
  • Overall exposure 3-9
  • Few studies
  • Exposure to carcinogens we dont know
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